1. Just-in-time adherence support systems in gamified cognitive training should be applied when participants are failing to reach key performance indicators such as highest level achieved, total game sessions played, and overall gameplay proportion. 

Evidence Rating Level: 2 (Good)

Mild cognitive impairment (MCI), Alzheimer’s disease (AD), and related dementias are three of the most common chronic illnesses that lead to memory loss and deterioration of cognitive skills. To support populations affected by these conditions, the current therapy focuses on pharmacological therapy and non-pharmacological interventions such as gamified cognitive training, which has been shown to increase adherence, motivation, and effectiveness. This paper aimed to identify predictors of adherence to gamified cognitive training which is essential for a just-in-time adherence support system. Machine learning algorithms were developed for each game that was tested. Surveys gathering participants’ baseline information was gathered including technical proficiency, self-efficacy, subjective cognition, perceived benefits, objective reasoning, objective processing speed, objective memory instant recall, and objective memory delayed recall. The study found that the best predictors of adherence were not demographics or baseline characteristics but rather game performance measures. Some of the indicators of performance they identified were highest level achieved, total game sessions played, and overall gameplay proportion. Interestingly, there was no association between the participant’s initial performance in the game and adherence. The number of sessions played however does predict adherence. Therefore, the ideal gamified cognitive training methods create a balanced of enticing participants to engage in many sessions quickly near the beginning of the training to promote adherence and then sustain long-term adherence with a balanced difficulty allowing constant improvement. 

Click to read the study in PLOSONE

Image: PD

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